Mental health/behavioral disorders have been increasing over recent decades and now affect approximately one out of five children and adolescents, creating a major public health epidemic. The three most common mental health problems in children and adolescents are anxiety disorders, depressive disorders, and attention-deficit/hyperactivity disorder with depression being the most costly primary mental health diagnosis. Early detection of and evidence-based intervention for mental health/behavioral problems is critical in order to prevent serious ongoing adverse outcomes. This chapter provides questionnaires that can be used for the purpose of collecting information on potential mental health/psychosocial problems from families in primary care or other types of pediatric and adolescent clinical settings. These questionnaires explore issues that parents and teens may be thinking about or reveal areas of concern. The chapter also presents screening tools that can be provided to children and adolescents.

Depressive disorders include major depressive disorder, persistent depressive disorder (dysthymia), disruptive mood dysregulation disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, and depressive disorder due to another medical condition. The common feature of depressive disorders is the presence of sad, empty, or irritable mood, which is associated with somatic and cognitive changes that interfere with functioning at home, in school and/or with peers. The risk in children/teens is increased if one or more parents are depressed. Depression is a risk factor for other high-risk behaviors and often precedes substance abuse by about four years. Depression is often misdiagnosed as ADHD in young children as they may present with inattention, impulsivity, and hyperactivity. This chapter provides a brief overview of depression and discusses the assessment and evidence-based management of depressive disorders in children and teens.

It is common for U.S. children to experience divorce of their parent, affecting more than 1 million every year. Several decades of research indicate that the outcomes for children and adolescents following divorce are determined by numerous factors that can increase risk or foster resilience. The risk of emotional, behavioral, social, and academic problems for children of divorced parents (25%) is more than double than that of children whose parents are continuously married (10%). Externalizing problems (e.g., acting out behaviors, impulsivity) have been consistently identified as the most common problems identified in children after divorce. Interparental hostility and lack of cooperation between parents following divorce is the most consistent predictor of poor outcomes among children. The child’s age at the time of divorce affects outcomes related to the developmental tasks associated with that age. This chapter describes the impact of marital separation and divorce on children and parents.

The prevalence of depression, burnout, suicidal intent, and chronic health conditions is higher in healthcare clinicians than in the general population. Pediatric clinicians face unique challenges when delivering patient care due to the complexity of the family dynamics and the special needs of caring for an ill child. Burnout consists of emotional exhaustion, no longer finding work meaningful, feeling ineffective, and a tendency to view patients, students, and colleagues as objects rather than as human beings. Conditions associated with burnout include headaches, tension, insomnia, fatigue, anger, impaired memory, decreased attention, thoughts of quitting work, drug and alcohol use, and suicide. Burnout not only has adverse effects on clinician population health and healthcare quality and healthcare safety, but it contributes to high turnover and substantial financial losses. Good self-care by pediatric clinicians and systems that support clinician wellness are imperative to prevent burnout, compassion fatigue, and other mental health disorders.

Primary care providers have become the main providers of mental health services for their patients. Building on long standing relationships with children and their families along with an emphasis on development, early intervention and prevention, pediatric practices are the ideal setting for the integration of mental health into primary care. One model for working with families that is being used successfully in many health care settings is SBIRT, which stands for screening, brief intervention, referral and treatment. This chapter presents brief interventions that are evidence-based interventions and can be provided by primary care providers in the context of brief office visits or several standard office visits. Brief interventions can be used as a stand-alone treatment for those at-risk as well as a vehicle for engaging those in need of more intensive specialized care.

Although obesity is a chronic medical condition, not a psychological disorder, many researchers and clinicians agree that the psychological and social impact of living with obesity is a risk factor in the development and persistence of mental health problems. In adults with mental health disorders, the prevalence of obesity is nearly twice as high as compared to adults without mental health disorders. The research evidence supports the predictive relationship of child emotional and behavioral problems (e.g., high levels of internalizing and externalizing behaviors) and the later life development of obesity or overweight. About 80% of adolescents with obesity will continue to be obese as adults. Psychological and social comorbidities associated with excess body weight in childhood and adolescence includes anxiety, depression, poor body image and self-esteem, and decreased social competence and academic achievement. This chapter discusses the assessment and management of obesity.

Anxiety disorders are the most common mental health problems in children and teens. Worries and fears are a normal part of a child’s development, but should not be excessive, interfere with functioning, or persist beyond developmentally appropriate periods. Youth with anxiety disorders experience severe and persistent distress that interferes with their daily functioning in school and in social interactions, affecting the child’s cognition, emotional regulation and behavior. Anxiety disorders are often comorbid with depression, bipolar, obsessive-compulsive, learning/language, eating, attention-deficit/hyperactivity disorder (ADHD), and substance related disorders. Children and teens with obsessive-compulsive disorder (OCD) have obsessions, compulsions or both, which are time-consuming and cause clinically significant distress or impairment in social, occupational or other areas of functioning. Routine mental health screening is recommended at all well-child visits and for presentation of symptoms or concerns. This chapter reviews evidence-based assessment and management of anxiety disorders and obsessive-compulsive disorder.

The reliable diagnosis of mental health disorders is essential for guiding appropriate evidence-based treatment along with identifying prevalence rates for the planning of mental health services and accurately documenting important public health information, such as morbidity and mortality rates. Mental health disorders are diagnosed according to criteria in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) by the American Psychiatric Association. Diagnostic criteria include symptoms, behaviors, cognitive functions, personality traits, physical signs, syndrome combinations, and durations requiring clinical expertise to differentiate from normal life variation and treatment responses to stress. Before a diagnosis is made, it is necessary to gain collateral information from multiple sources and to conduct a comprehensive interview with the child and family. This chapter describes general approach to the evidence-based management and prevention of mental health disorders in children and adolescents.

In healthcare, interprofessional teams comprised of members from different disciplines working together toward a common goal produce better outcomes. An effective and high-performing team is often the key differentiator between organizations that successfully accomplish their vision and those that do not. This chapter discusses the rationale for building and leading a high-performing team, describes two models that portray a team’s life cycle, and identifies key strategies for building and sustaining high-performing diverse and inclusive teams. Ultimately, interviewing should identify applicants with the position IQ and experience needed to function in the role. There are various approaches to interviewing applicants for positions in your organization, including open-ended unstructured interviews, more structured behavioral interviewing approaches, and motivationally based interviewing. Determining whether the applicant has the energy to persevere through adversity to find answers and reach solutions is key to a successful hire.